HNBA Executive/Judicial Endorsements Nomination Form Name:*FirstLast Address:* Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code E-mail 1:* E-mail 2:* Work Telephone:* Cell Number:* Are you a U.S. Citizen?*YesNo State whether you are a member of the HNBA:*YesNoSOCIAL MEDIAPlease provide links to your social media pages. Facebook: Twitter: Instagram: LinkedIn: FOR JUDICIAL CANDIDATES Are you applying for a specific judicial vacancy?*YesNo If so, which one?FOR EXECUTIVE ENDORSEMENT CANDIDATES List your top three preferred agencies, offices and positions:*SELF-CERTIFY Have you ever used illegal substances?*YesNo Have you ever been convicted of a misdemeanor or a felony?*YesNo Have you ever violated any federal tax, employment, criminal, or other laws?*YesNo If you answered YES to any of the above, please explain in detail.UPLOAD DOCUMENTS CV:* Judicial Endorsement Questionnaire OR Executive Appointment Certification Form:* Letters of Support (not required):SubmitReset